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Audiology and Hearing Aids

How Do I know if I Have Hearing Loss?

Hearing loss occurs to most people as they age. Hearing loss can be due to the aging process, exposure to loud noise, certain medications, infections, head or ear trauma, congenital (birth or prenatal) or hereditary factors, diseases, as well as a number of other causes. Recent data suggests there are over 34 million Americans with some degree of hearing loss. Hearing loss often occurs gradually throughout a lifetime. People with hearing loss compensate often without knowing they have hearing loss.

You may have a hearing loss if:

  • You hear people speaking but you have to strain to understand their words.
  • You frequently ask people to repeat what they said.
  • You don’t laugh at jokes because you miss too much of the story or the punch line.
  • You frequently complain that people mumble.
  • You need to ask others about the details of a meeting you just attended.
  • You play the TV or radio louder than your friends, spouse and relatives.
  • You cannot hear the doorbell or the telephone.
  • You find that looking at people when they speak to you makes it easier to understand.
  • You miss environmental sounds such as birds or leaves blowing.

If you have any of these symptoms, you should see an audiologist and an Ear, Nose & Throat Specialist to have a formal hearing evaluation.  This hearing test, or audiometric evaluation, is a diagnostic hearing test performed by a licensed audiologist. A diagnostic hearing test is not just pressing the button when you hear a beep. Rather, an audiometric evaluation allows the audiologist to determine the type and degree of your hearing loss and also indicates how well or how poorly you understand speech. Testing for speech understanding at different loudness levels and in different environments provides the audiologist with information about how successful amplification may be for your hearing loss.

The hearing evaluation should also include a thorough case history (interview) as well as a visual inspection of the ear canal and eardrum by the Ear, Nose & Throat physician. Additional tests of the middle ear function may also be performed. The results of the evaluation are useful to the Ear, Nose & Throat physician if the audiologist determines that your hearing loss may be treated with medical or surgical alternatives. Results of the hearing evaluation are plotted on a graph called an audiogram. The audiogram provides a visual view of your hearing test results across various pitches.  The audiogram and results from your speech understanding test are used to create a prescription and program the hearing aids.

Types and Causes of Hearing Loss

The type of hearing loss in any one person depends upon where in the ear the problem occur. The three main types are conducive, sensorineural, and mixed losses.

Conductive: A problem in the outer or middle ear causes conducive hearing loss. A conductive loss prevents sound from reaching the nerves in the inner ear. Common causes include:

  • Conditions associated with middle ear pathology such as fluid in the middle ear from colds, allergies, poor Eustachian tube function, ear infection, perforated eardrum, benign tumors
  • Impacted earwax
  • Infection in the ear canal
  • Presence of a foreign body
  • Absence or malformation of the outer ear, ear canal, or middle ear

Sensorineural: Damaged nerves in the inner ear cause sensorineural hearing loss. Sensorineural losses cannot be treated by surgery. There are many causes, differing by age of onset.

Before or During Birth:

  • Perinatal infections such as rubella, herpes, toxoplasmosis, syphilis, cytomegalovirus (CMV)
  • Heredity
  • Lack of oxygen at birth
  • Low birth weight
  • Certain defects of the head and neck

Later Onset:

  • Bacterial meningitis
  • Drug induced (ototoxicity)
  • Intense or excessive noise exposure
  • Physical damage to head or ear

Mixed: Sometimes, people will have problems both in the inner ear and in the outer or middle ear. This type of hearing loss is known as a mixed loss.

What Is Tinnitus and What Are the Causes of Tinnitus?

Tinnitus is the term for the perception of sound when no external sound is present. It is often referred to as "ringing in the ears," although some people hear hissing, roaring, whistling, chirping, or clicking. Tinnitus is not a disease but a symptom of another underlying condition – of the ear, the auditory nerve, or elsewhere. Tinnitus can be intermittent or constant, with single or multiple tones. Its perceived volume can range from very soft to extremely loud. Fifty million Americans experience tinnitus to some degree. Of these, about 12 million have tinnitus which is severe enough to seek medical attention. Of those, about two million patients are so seriously debilitated by their tinnitus, that their day to day functioning is affected. The exact cause (or causes) of tinnitus is not known in every case. There are, however, several likely factors which may cause tinnitus or make existing tinnitus worse: noise-induced hearing loss, wax build-up in the ear canal, certain medications, ear or sinus infections, age-related hearing loss, ear diseases and disorders, jaw misalignment, cardiovascular disease, certain types of tumors, thyroid disorders, head and neck trauma and many others. Of these factors, exposure to loud noises and hearing loss are the most common causes of tinnitus. Treating a hearing loss, either by medical management, if indicated, or with hearing aids, may offer relief of tinnitus. Other new and effective tinnitus treatments are also available. If you have tinnitus, a comprehensive hearing evaluation by an audiologist, and a medical evaluation by an otologist is recommended.

Types of Hearing Aids

There are many styles of hearing aids. The degree of the hearing loss, power and options required, manual dexterity abilities, cost factors, and cosmetic concerns are some of the factors that will determine the style the patient will use. Which one is right for you? That answer depends on your individual hearing loss and your personal listening needs. Our audiologist, Joy Martin, will work with you to determine the very best solution for you, your lifestyle, and your budget. We dispense a variety of hearing instruments, including entry level to premium level digital hearing aids. We use leading manufacturers to ensure that we are able to provide our patients with the most options and benefits based upon their lifestyle, needs and budget. Please ask us if you have a question about a specific manufacturer or brand.

Open Fit or Open Ear: These are currently the most popular hearing aids available. They are comfortable to wear, offer a wide array of features, and people barely notice you are wearing them.

Completely in the Canal (CIC): These hearing aids are tiny and fit, literally, completely in the ear canal.

Canal Style or In-The-Canal (ITC): These hearing aids fit in the ear canal and are somewhat visible.

Full Shell/In-The-Ear (ITE): These hearing aids fit slightly in the canal and fill the ear with a shell.

Behind-The-Ear (BTE): These hearing aids sit behind the ear and have a tube that connects the instrument to a custom made mold that fits in the ear.

What is Digital Hearing Aid Technology?

The term digital is used for most of today's current technology, from televisions to cell phones. Hearing aids today are digital, which means incoming sound is converted into a series of numbers which are then processed using mathematical equations. Digital processing enables very complex manipulation of sound, for example, to separate speech from noise.  A few digital hearing aids are capable of 1.8 million calculations per second.

The digital technology within hearing aids allows sounds to be separated into different frequency regions, or pitches, and amplify each region selectively, depending on the hearing aid user’s hearing loss. The processing within hearing aids also enables different amounts of amplification for soft, moderate, and loud sounds, so that soft sounds are audible, but loud sounds are not uncomfortable or over amplified. Digital processing enables a natural sound quality with minimal distortion, resulting in excellent sound quality.

Digital hearing aids are programmable, meaning the hearing aid settings can be precisely fine-tuned, and special features can be adjusted for each wearer by an audiologist, using special hearing aid software on a computer. Hearing aids are programmed and customized for both the hearing loss and the preferences of the person who wears them.

In addition to basic digital hearing aid technology, many hearing aid manufacturers offer several levels of advanced features made possible with digital processing technology. Digital hearing aids continue to advance and have become much more automatic.  These hearing aids are equipped with sophisticated features for people who regularly encounter challenging listening situations. Examples of some of these advanced features, what they do and how they benefit the hearing aid wearer are:

  • Directional Microphones: Two microphones on the hearing aids work together to give preference to sounds in front of the wearer and reduces sound, especially noise, from behind the wearer. This technology has been proven in research to improve speech understanding in background noise.  In some hearing aids, the focus point for speech can be to the right, left or behind the person.  This enhances listening benefit in difficult situations, such as the car.
  • Noise Reduction: Determines if signal contains unwanted background noise and reduces the level of background noise if present. Background noise is less annoying, and the user’s listening comfort is improved in noisy situations.
  • Feedback Management: Reduces or eliminates whistling that can occur with hearing aid use. Advanced technology eliminates any whistling from the hearing aid but does not compromise volume or sound quality.
  • Wind Noise Reduction: Reduces the noise created from wind blowing across the hearing aid's microphone(s). Designed to improve comfort for people who spend a lot of time outdoors.
  • Data Logging/Learning: The ability of the hearing aid to track and learn the hearing aid user’s preferences in various listening environments. This information can assist the hearing professional in making future programming adjustments and allows the hearing aid to adapt to the user’s preferences.
  • Bluetooth Interface: Establishes a wireless connection between hearing aids and Bluetooth compatible devices such as cell phones, computers, televisions, remote microphones, etc.

Hearing Aid Battery Information

All batteries are toxic and dangerous if swallowed. Keep all batteries (and hearing aids) away from children and pets. If anyone swallows a battery it is a medical emergency and the individual needs to see a physician immediately.  If a battery is swallowed, immediately call the 24-hour National Battery Ingestion Hotline at 202-625-3333 (call collect if necessary) or call your poison center at 1-800-222-1222.
The sizes of hearing aid batteries are listed below along with their standard number and color codes.
Size 10 YELLOW
Size 13 ORANGE
Size 312 BROWN
Size 675 BLUE
Today’s hearing aid batteries are “Zinc Air.” Because the batteries are air-activated, a factory-sealed sticker keeps them “inactive” until you remove the sticker. Once the sticker is removed from the back of the battery, it is active. Do not store zinc air batteries in the refrigerator.  Water particles will form under the sticker and oxygen will reach the battery. Batteries should be stored in a cool location.

Battery Safety Warning 
There was an incident where a used Zinc Air Cell Battery was stored for disposal jointly with other batteries in a film box and burst with a loud bang. If battery cells which are totally discharged come into electrical contact with one another, an unintentional charging, and in exceptional cases, bursting of the cell is possible. Batteries should be recycled.  Do not dispose of in fire, recharge, reverse polarity, or allow batteries to inadvertently contact metal objects or other batteries—they may leak or explode and cause injury.

Assistive Listening Devices (ALDs)

People with all types and degrees of hearing loss, even people with normal hearing, may benefit from an assistive listening device (ALD). Typically, a hearing aid makes all sounds in the environment louder. ALDs can increase the loudness of a desired sound, such as a radio, television, or a public speaker, without increasing the loudness of the background noises. This is because the microphone of the assistive listening device is placed close to the talker of device of interest, while the microphone of the hearing aid is always close to the listener.
Many types of ALDs are available for home use and larger public facilities.  Some ALDs include alarm clocks, TV listening systems, telephone amplifying devices, and auditorium-type assistive listening systems.  Many newer devices are small, wireless and compatible with a person’s digital hearing aids.  The ALD may be something small that attaches directly to the hearing aid, is activated through a program in the hearing aid, or is worn around the neck and transmits sounds wirelessly to the hearing aids.  Alarms and other home ALDs may be small devices that are placed discreetly on tables, next to the TV or on the wall.